Crusader Claims RCM

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Crusader Claims RCM Tennessee revenue cycle management company based in Cleveland, TN, serving Chattanooga and Southeast Tennessee.

Prior authorization is not going away, but the rules around it are changing.Some of the new federal rules are already in...
10/27/2026

Prior authorization is not going away, but the rules around it are changing.

Some of the new federal rules are already in effect. Covered payers now have set decision timeframes and must give a specific reason when they deny a request. The larger electronic piece arrives on January 1, 2027, about nine weeks from now.

If you run a small practice, a rural clinic, or a behavioral health clinic, this is a good month to ask your payers and your EHR vendor where they stand. Our new post walks through who is covered, what to check, and a few low-effort steps to start with.

CMS-0057-F set prior authorization deadlines for 2026 and 2027. See who is covered, what changed, and what small practices should do now.

An outdated insurance ID or a skipped eligibility check often starts as a small front-desk issue and returns later as a ...
10/27/2026

An outdated insurance ID or a skipped eligibility check often starts as a small front-desk issue and returns later as a denial. The rework pulls staff from other accounts and can create coverage surprises for patients. Automated checks during registration help catch these problems while they are still easy to fix.

Revenue loss often begins at registration, even though it is discovered after adjudication. An outdated insurance ID or a skipped eligibility check looks minor at the front desk. Weeks later it returns as a denial.

MedPAC staff presented data showing that a common telehealth office visit requires significantly lower direct practice e...
10/26/2026

MedPAC staff presented data showing that a common telehealth office visit requires significantly lower direct practice expenses than the same visit delivered in person. The difference is driven mainly by reduced clinical support time.

The commission is also reviewing incident-to billing, under which nurse practitioners and physician assistants can currently be paid at the full physician rate when services are billed under a supervising physician. A new modifier for telehealth services billed this way is set to take effect in 2027.

Lower pay for telehealth, direct billing for NPs and PAs come up for discussion.

Epic released Connectors so its AI agents can work with third-party applications. The revenue cycle agent Penny is among...
10/23/2026

Epic released Connectors so its AI agents can work with third-party applications. The revenue cycle agent Penny is among those that can retrieve information and perform actions without leaving the main system. Organizations will review permissions before enabling any Connector.

A new developer capability connects information and initiates actions by importing data from another application into a health system's electronic health record and allowing an EHR to complete tasks in other apps.

A new Peterson-KFF analysis of hospital price transparency files after the 2026 reporting changes shows that five issues...
10/22/2026

A new Peterson-KFF analysis of hospital price transparency files after the 2026 reporting changes shows that five issues continue to complicate price comparisons. Base and final rates remain difficult to distinguish, and newly required data fields frequently appear empty. Practices that review public rates for contracting context should note the remaining limitations.

An analysis finds five persistent issues with hospital price transparency files that continue to hinder price comparisons despite new guidance aiming to clarify costs.

Hospital median operating margins moved from negative early in 2026 into positive results by June, based on data from mo...
10/21/2026

Hospital median operating margins moved from negative early in 2026 into positive results by June, based on data from more than 2,200 facilities. Systems are tightening costs and adjusting service lines ahead of Medicaid changes scheduled for 2027 that will reduce enrollment and provider payments. Emergency department volume is expected to increase as coverage contracts.

Hospital financial performance improved through June 2026, but Medicaid reimbursement reductions are prompting CFOs to rethink costs.

UnitedHealthcare eliminated prior authorization requirements for roughly 1,700 medical codes as of October 1. The change...
10/20/2026

UnitedHealthcare eliminated prior authorization requirements for roughly 1,700 medical codes as of October 1. The change covers about 30 percent of its preapproval requirements and applies to commercial, Medicare Advantage, Medicaid, ACA, and Oxford plans. Code lists differ by product, so practices should verify specific services against the published lists for each plan type.

The list tells providers what treatments will no longer need preapproval this October, part of UnitedHealthcare’s pledge to cull 30% of its much-maligned utilization management controls. The codes span a broad range of services.

States including Alabama, Iowa and Washington now limit health insurers from using artificial intelligence as the sole b...
10/19/2026

States including Alabama, Iowa and Washington now limit health insurers from using artificial intelligence as the sole basis for denials or delays in care. A licensed clinician must review the adverse decision under several of these laws, and Illinois will require human review of every automated downcode starting in 2028. Self-funded employer plans generally fall outside state insurance rules, so plan type remains the first check on any appeal.

States are limiting AI in coverage decisions. How billing teams can cite the laws on appeal, and why self-funded plans fall outside them.

10/16/2026

One setting in your practice-management system can cause secondary claims to reject after Medicare pays as primary, even when the remittance is clean.

It treats contractual adjustments as payments, so the residual balance is wrong. Secondaries then reject for COB out of balance.

We broke down the setting and the fix:

A common PM setting treats Medicare contractual adjustments as payments, so secondary claims after Medicare reject for COB out of balance. Here’s the fix.

10/16/2026

MGMA's 2026 compensation and productivity report finds work RVUs down in 16 of 23 specialties while median total compensation rose. Encounters declined in every specialty measured. A CMS efficiency adjustment cut wRVU values 2.5 percent on roughly 7,700 non-time-based codes effective January 1.

Physician pay rose in 2025 even as productivity fell, MGMA data shows. MGMA's Andy Swanson on what the split means for practices.

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1025 Peerless Xing NW
Cleveland, TN
37312

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Monday 8am - 5pm
Tuesday 8am - 5pm
Wednesday 8am - 5pm
Thursday 8am - 5pm
Friday 8am - 5pm

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+14233229727

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